Provider Demographics
NPI:1629302633
Name:SHRINER, BROOKE CHRISTIAN (PHD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:CHRISTIAN
Last Name:SHRINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-429-8640
Mailing Address - Fax:502-426-2283
Practice Address - Street 1:4912 US HIGHWAY 42
Practice Address - Street 2:SUITE 104
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6349
Practice Address - Country:US
Practice Address - Phone:502-429-8640
Practice Address - Fax:502-426-2283
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY130741103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100153420Medicaid
IN201012380AMedicaid
IN300000550 (KOHMG)Medicaid
KY000000709956OtherANTHEM BC/BS
KY000000709956OtherANTHEM BC/BS
KY7100153420Medicaid